1851620066 NPI number — WILLIAM BURKE LTD

Table of content: (NPI 1851620066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851620066 NPI number — WILLIAM BURKE LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM BURKE LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MAIN AT LOCUST PHARMACY AND CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851620066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2151 KIMBERLY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETTENDORF
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-324-1641
Provider Business Mailing Address Fax Number:
563-884-4480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 W LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52803-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-324-5004
Provider Business Practice Location Address Fax Number:
563-324-3305
Provider Enumeration Date:
12/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PLOEHN
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
563-324-5004

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  16D0922143 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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